Background

Patients in mental health/learning disabilities facilities often have more underlying physical health problems than the general population, which predispose them to risk factors for healthcare associated infections (HCAIs). Since they are often “revolving door” patients for acute healthcare facilities, infection prevention and control (IPC) is equally important in the mental health/learning disabilities setting. Some patients can also pose challenges due to underlying mental health or learning disabilities.

Service users and their carers are crucial to service improvement and in contributing to strategy in this area, so the nurse consultant infection control programme seeks to involve them in IPC to ensure that:

Their views are represented on the infection prevention and control committees;

They are actively involved and engaged in IPC.

From 2009 all trusts had to be registered with the Care Quality Commission (CQC) and comply with the Health and Social Care Act (2008). The outcome measures are now much more focused on patient outcomes than processes. This means service user involvement is crucial to addressing the IPC agenda. In addition, service user involvement and IPC are key trust objectives.

The process

After a presentation at the joint service user and carers involvement forum the nurse consultant asked for volunteers to become involved with IPC in the trust. Four people volunteered and briefing sessions were held to familiarise them with the subject before they attended the IPC committee and link practitioner group meetings.

Further involvement has included:

Patient information and policy/pathway development;

Auditing ward practices such as hand hygiene, cleanliness of environment and patient equipment;

Unannounced spot-checks to help quality control/assurance of the main audit programme;

Helping with hand hygiene campaigns at the trust;

Participating in a review of decontamination of patient care equipment such as beds and mattresses;

Presenting their work at the service user involvement conference;

Representation on decontamination and nutrition groups.

The service users also offer feedback at the joint service user and carer involvement forum, previously the nurse consultant’s role.

Advice to other organisations

The scheme has run relatively easily. There were initial concerns about service user involvement in ward audits but this was alleviated as they are accompanied at all times by the nurse consultant and a ward staff member.

In order to ensure the success of service user involvement it is vital that they are briefed thoroughly and have enough support and training to give them the confidence to contribute. Going through the agenda with them before any committees ensures they are fully briefed — while this may be time consuming it helps to get the best out of their involvement.

The nurse consultant has worked closely with the service user representatives to ensure they understand how audits are undertaken. They have learnt quickly and their contribution has been invaluable, not only in helping to action changes but also because their own backgrounds give a fresh perspective.

Benefits of the initiative

It is difficult to measure a reduction in HCAIs as an outcome measure, as rates overall remain low. However, a significant improvement has been seen in compliance with practice across the organisation. Hand hygiene compliance has improved from 45% to 95%, and 90% of areas passing the environmental audits — an increase from 47%. Patient satisfaction surveys have also showed increased cleanliness scores. While this cannot be attributed entirely to the initiative, it has played a significant part.

Just as importantly, service users have found the initiative beneficial. At a service user involvement conference they gave emotive speeches about how much their work had increased their confidence; it has helped them to feel valued and to realise that their support is very much acknowledged and appreciated and has also made a positive difference to other service users.

Financial implications

There were no financial costs involved in setting up the scheme. Ongoing costs include service users being paid travelling expenses to attend meetings and travel across sites. They are also paid a nominal amount to attend committee meetings by the Service Users and Carers Involvement Scheme.

Future plans

The service users and nurse consultant jointly presented the initiative at this year’s trust service user involvement conference and hope to collaborate on writing it up for publication. The nurse consultant also spoke at the National Infection Prevention Society Annual Conference.

Trust comment

Trust chairman Bernard Pilkington said: “As a trust we pride ourselves on service user involvement at every level. Eileen McDonnell and Harry Blackman have played a hugely significant role in helping us to improve our infection prevention control service and contributing to our strategy in this area.

“As chairman, I would like to thank everyone involved in the nurse consultant infection control programme and congratulate them on this significant personal achievement.”